Superiority of Closure Devices over Conventional Sutures in Left Atrial Appendage Closure (LAAC)

Background: Although the major source of thrombi in patients with atrial fibrillation is the left atrial appendage (LAA), closure during open heart surgery is not recommended any more - most probably due to the high number of insufficient closures. We present a prospective, echo-controlled study on the efficacy of LAAC during open heart procedures comparing conventional suture techniques and new closure devices.

Patients and Methods: From 8/2013 to 4/2015, 65 patients (19 female) with atrial fibrillation at the time of surgery undergoing various open heart procedures were included. 23 patients underwent CABG, 13 AVR, 3 MV-replacement, 2 had MV-repair and 24 patients combined procedures. LAAC was performed in all subjects by conventional purse- string sutures or by a stapling device (TigerPaw, Maquet), as to the surgeon's preference. In 62 an additional radiofrequency ablation was performed. All patients were examined by TEE before hospital discharge and 3 months after surgery.

Results: The overall rate of sufficient closures was 46.1% (30 patients). If conventional techniques were used, the success rate after 3 months was as low as 18%. Using closure devices, the rate of sufficient LAACs was 83%.

Conclusion: Obviously, the use of closure devices for LAAC is superior to conventional surgical closure. This study justifies prospective randomized clinical trials and most probably re-evaluation of the existing recommendations in the guidelines.